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Spay/Neuter Voucher Application
* In order to submit this form, you must answer all questions. Thanks!
How did you hear about us?
 Store  Craigslist  Website
  Word of Mouth  Virtual Pet Adoptions  Advertising
 Pet Finder  Video advertising  Other
Tell us about you
First Name
Last Name
Address
City:
State: Zip:
Day Phone: Evening Phone:
Email:
 
How many people in Home?
Ages
Are you currently employed? Yes No 
Total Monthly Income?
Are you currently recieving goverment assistance? Yes No 
If yes, what is the monthly amount?
What type?
Tell us about your pet
Cat Dog 
Name?
Breed/description?
Color?
Gender? male female 
Age?
weight?
Where did you get your pet?
Do you have a regular Veterinarian? yes no 
If yes, who?
Is your pet current on vaccines? yes no 
Does your pet have a rabies vaccine? yes no 
Has your pet ever bitten anyone? yes no 
If yes, explain?
Hopalong Animal Rescue is currently working with a Veterinarian in Fremont who has agreed to greatly reduce his regular prices for those who cannot otherwise afford to have their pets spayed or neutered. This program has been created for pet owners with genuine financial need.

Our cost to spay/neuter a cat is $60. Our cost to spay/neuter a dog is $100.

What amount are you able to contribute?

Do you have reliable transportation to and from Fremont: yes no 

Owners schedule the surgery with our partner veterinary clinic in Fremont and must be able to transport their pet to and from the clinic. Once your appointment is scheduled, you are not permitted to reschedule an appointment, nor are you allowed to bring a different animal from this application. Other services may be offered to you at the time of surgery. If you choose to get these they are your responsibility to pay for at the time of service.

 
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